Provider Demographics
NPI:1003950957
Name:JEFF W MEINCKE-REZA M D
Entity Type:Organization
Organization Name:JEFF W MEINCKE-REZA M D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPEDIC SURGERN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:W
Authorized Official - Last Name:MEINCKE-REZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-416-2663
Mailing Address - Street 1:1014 MEMORIAL DR STE 314
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-2084
Mailing Address - Country:US
Mailing Address - Phone:903-416-2663
Mailing Address - Fax:903-416-2664
Practice Address - Street 1:1014 MEMORIAL DR STE 314
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-2084
Practice Address - Country:US
Practice Address - Phone:903-416-2663
Practice Address - Fax:903-416-2664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6887174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0036JTOtherBLUE CROSS AND BLUE SHIEL
TXP00007908OtherRAILROAD MEDICARE
TX3101855OtherAETNA INSURANCE
TX5018900001Medicare NSC
TXG91637Medicare UPIN
TX00881UMedicare PIN